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病毒性肝炎的诊断目前仍主要依靠临床表现及非特异的肝功能检查,除乙型肝炎外,而甲型、非甲非乙型肝炎等的特异性病原学诊断方法,均尚不能广泛应用于临床,因之常仅以黄疽、肝脏肿大、肝功损害作为初步诊断的条件,其中有一些病例可能被误诊,今特报告两个特殊病例,其最后诊断均排除病毒性肝炎而系肝外疾病所致。【例1】男孩,10岁,住院号1287,于1980年10月9日入院。入院前两个月始厌油、恶心、呕吐、纳差。检验:谷丙转氨酶500单位,硫酸锌浊度试验20单位,诊为“肝炎”。一个月前咳嗽偶呈痉咳,吐白色粘痰,伴发热以下午及晚间著,且有盗汗,5天前跟脸颜面浮肿、尿少色黄、乏力、自觉肋下隐痛,无关节痛。一年前患“淋巴结核”经治疗至今未愈。查体体温36.4℃,发育中等,营养欠佳,神志清,面色苍黄,巩膜无黄染,全身浅淋巴结均肿大似黄豆或蚕豆大、活动、无压痛,心脏听诊律齐、无杂音、心率108次/分,腹软,肝在肋下3厘米剑突下2厘米,质中等,无压痛。脾肋下2厘米,质中等。入院时检查黄疸指数正常,谷丙转氨酶210单位,麝香草酚浊度试验2单位,硫酸锌浊度试验20单位,血红蛋白8.5克%,红细胞300万/立方毫米,白细胞
The diagnosis of viral hepatitis is still mainly rely on clinical manifestations and non-specific liver function tests, in addition to hepatitis B, and A, non-A non-Hepatitis B and other specific etiological diagnosis methods are still not widely used Clinical, often due to jaundice, liver enlargement, liver damage as a preliminary diagnosis of conditions, some of which may be misdiagnosed, this special report two special cases, the final diagnosis of viral hepatitis are excluded and the Department of liver External disease caused. [Example 1] Boy, 10 years old, hospital number 1287, was admitted to hospital on October 9, 1980. Two months before admission tired of oil, nausea, vomiting, anorexia. Test: alanine aminotransferase 500 units, 20 units of zinc sulfate turbidity test, diagnosed as “hepatitis.” Cough even a month ago spasm cough, spit white phlegm, with fever in the afternoon and evening, and night sweats, with facial swelling 5 days ago, less urine yellow, fatigue, subtle spontaneous pain, no joint pain. A year ago suffering from “lymph node tuberculosis” has not healed after treatment. Examination of body temperature 36.4 ℃, moderately developed, poor nutrition, clear consciousness, pale yellow, scleral no yellow dye, systemic superficial lymph nodes are swollen like soybeans or broad beans, activity, no tenderness, heart auscultation Qi, no noise, heart rate 108 beats / min, abdominal soft, liver in the ribs 3 cm xiphoid 2 cm, medium quality, no tenderness. Spleen ribs 2 cm, medium quality. Admission to check the normal index of jaundice, alanine aminotransferase 210 units, 2 units of thymosin turbidity test, 20 units of zinc sulfate turbidity test, hemoglobin 8.5 g%, erythrocyte 3 million / cubic mm, white blood cells